Surgery for Back Pain

Options to consider when conservative treatments don't bring relief.

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If you have a problem that can be physically corrected, such as a herniated disc, spinal stenosis or spondylolisthesis, surgery is an option worth considering – particularly when more conservative treatments fail to relieve your pain. To treat other problems, such as a serious infection or tumor, surgery may be a medical necessity.

The following are some of the most common back surgeries:

Discetomy. Discectomy is removal of part of a disc that is herniated and causing pain or other symptoms. There are two types of discectomy:

• Percutaneous, which involves removing a portion of the disc, using a laser or suction device, through a narrow probe placed through a small incision in your back.• Microsurgical, which requires a small incision, usually less than inch long. During this type of discectomy, the surgeon, using a microscope, removes the damaged portion of the disc along with a small portion of the bone covering the spinal canal.

Laminectomy. Laminectomy is a surgery performed to enlarge the spinal column when spinal stenosis (narrowing) causes pressure on the nerve roots. A laminectomy involves removing the lamina, the backside of the spinal canal that forms a roof over the spinal cord. Along with lamina, doctors often remove any bony protrusions, or spurs, which may have formed as a result of osteoarthritis of the spine.

Spinal Fusion. Spinal fusion is a welding process by which two or more vertebrae are fused together for form a single immobile unit. It is used to stop the motion that normally occurs between the vertebrae and, in doing so, relieve pain that is caused or aggravated by movement, such as bending, lifting or twisting, or to stabilize a spine that has been damaged by infections or tumors. It also may be used to stop the progression of a spinal deformity, such as scoliosis, to treat injuries of the vertebrae, or to stabilize vertebrae that become loose due to a defect in the facet joint.

Vertebroplasty and kyphoplasty. These two similar procedures are performed to relieve the pain and, possibly, other problems associated with compression fractures of the vertebrae. Both involve bolstering fractured bone with a cement-like material that is injected into the vertebra or vertebrae through a needle about as big around as a cocktail straw. Although the two procedures are essentially the same, kyphoplasty involves an additional step. Just before injecting the cement material, the doctor places a small balloon-like device into the compressed vertebra and inflates it. The goal of this additional step is to help restore height to the crumbled vertebra, which will reduce deformity.